When no blood reaches a section of the lung, that portion of the lung suffers an infarct, meaning it dies because no blood or oxygen is reaching it. This is referred to as a pulmonary (or lung) infarct.
Pulmonary embolism is the sudden blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)-usually a blood clot (thrombus) or rarely other foreign material.
Pulmonary embolus is the end result of a deep vein thrombosis or blood clot elsewhere in the body. Most commonly deep vein thrombosis’ are seen in the leg, but can also occur in veins within the abdominal cavity or in the arms.
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A pulmonary embolus may present with the sudden onset of chest pain and shortness of breath. The pain is classically sharp and worsens when taking a deep breath, often called pleuritic pain or pleurisy. There may be cough that produces bloody sputum.
The patient may have stable vital signs (blood pressure, heart rate, respiratory rate, and oxygen saturation) but frequently presents with an elevated heart rate. A severe pulmonary embolus can present with shock (low blood pressure) or cardiac arrest, particularly when a large clot blocks the outflow of blood from the right side of the heart to the lungs (saddle embolus). Depending on the amount of blood clot (clot burden or clot load), oxygen saturation can be variably compromised as can the blood pressure and heart rate. In a classic presentation, the heart rate and respiratory rate are elevated as the body tries to compensate.
A blood clot inside the deep veins of the legs is called deep venous thrombosis. If a piece of the clot breaks off and travels to the lungs, the clot in the lungs is called a pulmonary embolus. Clots in the deep veins of the legs and lungs can lead to tissue damage or even fatal complications.
Doctors use blood thinners to help dissolve clots and prevent repeated clots. For many years, they most often used a blood-thinning drug known as unfractionated heparin (UFH). Patients get UFH through a needle in a vein for a few days while they are in the hospital. The dose of UFH is monitored closely each day to check the amount of blood thinning that occurs. More recently, doctors have been using another preparation of heparin, low-molecular-weight heparin (LMWH). It is injected under the skin, can be given at home, and does not require close monitoring of the dose. Several studies show that LMWH is a safe and effective drug for treating blood clots in the legs. However, we know less about the relative benefits of LMWH versus UFH in the treatment of patients with clots in their lungs.
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